scholarly journals A Case of Early Disseminated Neurological Lyme Disease Followed by Atypical Cutaneous Manifestations

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Vamsi Kantamaneni ◽  
Vikas Sunder ◽  
Mohammad Bilal ◽  
Scott Vargo
Keyword(s):  
Lyme Disease ◽  
Tertiary Care ◽  
Sensu Stricto ◽  
The Body ◽  
Care Hospital ◽  
Lower Extremity Weakness ◽  
Cutaneous Manifestations ◽  
Stool Incontinence ◽  
Western Blot Testing ◽  
High Index Of Suspicion

Lyme disease (LD) is a tick-borne illness caused by Borrelia burgdorferi sensu stricto. An 80-year-old female from Pennsylvania, USA, presented to an outside hospital with fever, confusion, lower extremity weakness, and stool incontinence. CT head and MRI spine were unremarkable. An infectious work-up including lumbar puncture was negative. She was transferred to our tertiary care hospital. Patient was noted to have mild unilateral right-sided facial droop and a diffuse macular rash throughout the body. She denied any outdoor activities, tick bites, or previous rash. Intravenous ceftriaxone was started for suspected LD. The patient’s symptoms including facial droop resolved within 24 hours of antibiotic therapy. Polymerase chain reaction of the blood, IgM ELISA, and IgM Western blot testing for LD came back positive a few days after initiation of therapy. She was treated for a total of 21 days for neurological LD with complete symptom resolution. Not all patients have the classic “targetoid” EM rash on initial presentation, rash could develop after neurological manifestations, and prompt initiation of antibiotics without awaiting serology is paramount to making a quick and a full recovery. There should be a high index of suspicion for early disseminated LD, as presentations can be atypical.

scholarly journals Epidemiological, clinical profile and outcome of multi-system inflammatory syndrome in children (MIS-C) admitted in government tertiary care hospital of Kanyakumari district

2021 ◽  
Vol 8 (11) ◽  
pp. 1879
Author(s):  
Steeve Gnana Samuel ◽  
Suresh Placode Monikanta ◽  
Arul Prasath Subramoniam Vasudevan ◽  
Nagalekshmi Rajamanickam
Keyword(s):  
Tertiary Care ◽  
Gastrointestinal Symptoms ◽  
Signs And Symptoms ◽  
Intensive Care Treatment ◽  
Care Hospital ◽  
Cutaneous Manifestations ◽  
Female Ratio ◽  
Wide Range ◽  
High Index Of Suspicion ◽  
Inflammatory Syndrome

We report twelve children with a median age of 7 year (IQR 3years to 12 years) who fulfilled MIS-C WHO criteria. The male to female ratio was 2:1. Affected children had gastrointestinal symptoms (92%), respiratory symptoms (67%), cardiovascular symptoms (58%), neurological symptoms (50%), renal symptoms (33%), followed by muco-cutaneous manifestations (25%). 83% of children had lymphocytopenia. It was found that lymphocytopenia was directly correlated to disease severity. The majority of the children had elevated CRP, transaminase, and deranged coagulation profiles. All 4 systems were involved in 7 children (58%). Intensive care treatment was required for all the cases (100%). There were no deaths. Children with coronavirus disease 2019 (COVID-19) associated MIS-C can present with a wide range of signs and symptoms. They can deteriorate quickly and hence a high index of suspicion; early referral and early initiation of treatment with steroids and IVIg can save the lives of children with MIS-C.

Characteristics and Laboratory Findings of Food-Induced Anaphylaxis in Children: Study in an Asian Developing Country

2021 ◽  
pp. 1-9
Author(s):  
Rapisa Nantanee ◽  
Narissara Suratannon ◽  
Pantipa Chatchatee
Keyword(s):  
Developing Country ◽  
Immunoglobulin E ◽  
Tertiary Care ◽  
Elevated Serum ◽  
Cow’S Milk ◽  
Care Hospital ◽  
Serum Tryptase ◽  
Cutaneous Manifestations ◽  
Cow's Milk ◽  
Geographical Regions

<b><i>Introduction:</i></b> Food allergy is the major cause of pediatric anaphylaxis. Characteristics and triggers may be different in different geographical regions. Studies focusing on food-induced anaphylaxis (FIA) in Asian developing countries are limited. Our study aimed to study characteristics of FIA in a tertiary care center in an Asian developing country. <b><i>Methods:</i></b> Retrospective review of pediatric anaphylaxis admission and outpatient visit at a tertiary care hospital in Bangkok, Thailand during 2008–2018 was performed. Data regarding clinical presentation, place reaction occurred, time of onset, investigations (serum tryptase, specific immunoglobulin E, and skin test), treatment, and follow-up periods were collected. <b><i>Results:</i></b> One hundred seventy-four anaphylaxis admission records of which 61 episodes of FIA were retrieved. Data from outpatients visit consisted of 17 patients. Most patients were male (76.7%). The median age was 7.1 years (interquartile range 1.9–12.4). The major causes of FIA were shrimp/shellfish (37%), wheat (15.1%), and cow’s milk (11%). Food causing anaphylaxis varied according to age-group: infants had anaphylactic reactions to egg, wheat, and cow’s milk, preschools to wheat and peanut, and older children to shrimp/shellfish. Cutaneous manifestations occurred in all patients, followed by lower respiratory tract symptoms (83.6%) and gastrointestinal symptoms (50.8%). There was no biphasic anaphylaxis reported. Elevated serum tryptase was found in only 4 patients (7%). <b><i>Conclusion:</i></b> Recognizing characteristics of pediatric FIA is crucial. The common causes of FIA in our study in Asian children were egg in infants, wheat and peanut in preschool children, and shrimp/shellfish in school-age children and adolescents. Skin manifestation presented in all patients with FIA.

A CLINICOEPIDEMIOLOGICAL STUDY ON PAEDERUS DERMATITIS IN A TERTIARY CARE CENTRE, CHENNAI

2021 ◽  
pp. 25-27
Author(s):  
P. Mohan ◽  
P. Revathi Guru ◽  
V. Sudha ◽  
L. Balamurugan ◽  
Pavithra Gunasekaran ◽  
...  
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Sudden Onset ◽  
The Body ◽  
Care Hospital ◽  
Age Group ◽  
Common Condition ◽  
Tertiary Care Centre ◽  
Linear Lesions ◽  
Paederus Dermatitis

Paederus dermatitis is a form of irritant contact dermatitis due to contact with certain insects of the genus Paederus presenting with mostly erythematous linear lesions of sudden onset on exposed parts of the body. To study the clinico epi Aim: demiological features in patients with Paederus dermatitis. A retrospective analysis of clinicoepidemiological Materials & Methods: features of patients affected with Paederus dermatitis who had attended the Dermatology OPD, in a tertiary care hospital between January 2018 to December 2019 was done. All the required data had been collected from the OPD records and details were tabulated and analysed. A total of 56 patients had been affected with Result: Paederus dermatitis during the study period, of which 32 were males and 24 were females. 41out of 56 (73.21%) of patients presented between the months of August and December. Most common age group affected were between 11 to 30 yrs, with front and back of neck being the most common affected sites. In 42 out of the 56 patients the lesions resolved with post inammatory hyperpigmentation. Conclusion: Paederus dermatitis is a common condition that is often misdiagnosed and hence awareness is required for the clinicians and the general public to prevent it.

scholarly journals A comparative study of impact on cognitive function between diabetic and non-diabetic patients in a tertiary care hospital

2018 ◽  
Vol 7 (8) ◽  
pp. 1547
Author(s):  
Dharnaben A. Patel ◽  
Dhruv J. Patel ◽  
N. D. Kantharia
Keyword(s):  
Cognitive Function ◽  
Cognitive Decline ◽  
Tertiary Care ◽  
The Body ◽  
Diabetic Patients ◽  
Care Hospital ◽  
Proper Understanding ◽  
History Of ◽  
Control Of Diabetes ◽  
The Brain

Background: Diabetes Mellitus is a chronic metabolic disorder characterized by hyperglycemia, polyuria, hyperlipidemia etc, resulting from defects in insulin secretion, insulin action or both. It affects various organs of the body including the brain. Cognitive function is the thinking process of the brain. In any chronic disease evaluation of cognitive function is justified as it may affect various common day to day activities.Methods: It is a prospective, observational and non-interventional study. Thirty diabetic patients who were recently started on insulin i.e. within 7 days were enrolled in the study based on inclusion and exclusion criteria. Thirty non diabetic healthy individuals served as a control. Cognitive function was accessed by Adenbrooke’s Cognitive Examination (ACE III) at the time of enrollment.Results: The results were analysed using paired t-test. Attention, Memory and Visiospatial ability was significantly reduced in diabetic patients compared to control. Verbal fluency and language was also reduced but the change was not significant. Total ACE III score was significantly reduced in diabetic patients compared to control.Conclusions: Cognitive function is significantly reduced in Diabetic patients recently started on insulin. Hyperglycemia could be the possible reason of cognitive decline. Proper understanding of the natural history of Diabetes and the pathogenesis of cognitive decline as well as control of Diabetes can help to prevent development of cognitive dysfunction.

scholarly journals Pattern of dermatologic manifestations in polycystic ovarian disease cases from a tertiary care hospital

2018 ◽  
Vol 5 (1) ◽  
pp. 197 ◽  
Author(s):  
Preeti Jain ◽  
Shailendra Jain ◽  
Abhishek Singh ◽  
Shewtank Goel
Keyword(s):  
Lifestyle Modification ◽  
Tertiary Care ◽  
Care Hospital ◽  
Cardiovascular Risks ◽  
Polycystic Ovarian Disease ◽  
Cutaneous Manifestations ◽  
Ovarian Disease ◽  
General Physical Examination ◽  
Female Pattern Hair Loss ◽  
Dermatologic Manifestations

Background: Dermatologists often play a significant role in its management. Cutaneous features of hyperandrogenism in Polycystic ovarian syndrome (PCOS) have varied presentation. Aim of this study was the pattern of dermatologic manifestations in polycystic ovarian disease in northern Indian females.Methods: Patients registering for treatment of polycystic ovarian disease at Dermatology outpatients department during April 2016 to March 2017 formed the study population. Residents interviewed the study subjects at the OPD. General physical examination, systemic examination, breast and pelvic examination, along with detailed dermatological examination were conducting after taking the history. Hormonal analysis was performed after an overnight fasting using enzyme immunoassay.Results: FSH and LH levels were 5.05±1.86 IU/L and 8.14±5.21 IU/L respectively. Testosterone levels were found to be 61.01±25.32 ng/dl. DHEAS levels among them were 130.05±41.21μg/dl. Two commonest cutaneous manifestations were hirsutism and acne seen in 83.8% and 59.5% of subjects. Female pattern hair loss was seen in 45.6% females. Three most frequent hormonal abnormalities noted in our study subjects were raised L/H ratio, testosterone and LH levels seen in approximately 45%, 35% and 21% cases.Conclusions: The cutaneous manifestations of PCOS reserve a major role in its management by dermatologists. A lifestyle modification along with systemic treatment remains mainstay of treatment. Monitoring for the foreseen cardiovascular risks should start early to downgrade the morbidity.

SONOGRAPHIC MEASUREMENTS OF SCROTAL WALL THICKNESS

2021 ◽  
pp. 31-32
Author(s):  
Sahil Gandhi ◽  
Asit Natekar
Keyword(s):  
Wall Thickness ◽  
Tertiary Care ◽  
The Body ◽  
Wall Thickening ◽  
Temperature Sensitive ◽  
Main Function ◽  
Care Hospital ◽  
Sperm Production ◽  
Time Duration ◽  
Anterior Posterior

Main function of scrotum is to hold testes at optimal temperature for spermatogenesis. Sperm production in the testes is a temperature sensitive process. It requires an environment that is 2 to 6°C cooler than the body core. The temperature of the testes is regulated by the scrotal wall. Tunica dartos muscle changes the surface area of the scrotal skin by contracting or relaxing depending on the ambient temperature. This study postulates that if the thickness or the tone of this muscle is more thereby contributing to scrotal wall thickening, it will hamper the thermoregulation and spermatogenesis leading to poor sperm production. This could be an besides varicocoele another cause of male infertility which has been an established cause. This study will help to suspect the patients of infertility caused by thick scrotal wall. This study is aimed to study scrotal wall thickness and with the help of Ultrasonography. to establish norms The study was conducted at department of Radio-diagnosis at the tertiary care hospital, Sangli. The study started after approval of institutional ethical committee. This is a cross sectional observational study for the duration of 4 months. Total number of 50 cases was achieved in this time duration which satised the inclusion criteria. Statistical method used was Student's T test. Scrotal ultrasonography was performed using linear and curvilinear probe with sta (5-12 MHz) (2-5 MHz) on Philips Afniti50, after ndoff pad allowing some time for the dartos muscle to relax and scrotal wall thickness is measured on either side on three surfaces (anterior, posterior and lateral) and means were obtained. This study found that there was no difference between anterior, posterior, lateral wall thicknesses on ipsilateral side or contralateral side. There is no need to take three different wall thicknesses and convenience and suitability of any scrotal wall thickness would be equally effective.

scholarly journals Outcome of Internal Fixation of Metacarpal Fractures of Hand at a Tertiary Care Hospital, Kathmandu

2019 ◽  
Vol 21 (1) ◽  
pp. 35-39
Author(s):  
Praphulla Shrestha ◽  
SR Paudel ◽  
P Chalise
Keyword(s):  
Pain Relief ◽  
Internal Fixation ◽  
Tertiary Care ◽  
Kirschner Wire ◽  
The Body ◽  
Care Hospital ◽  
Metacarpal Fractures ◽  
Active Flexion ◽  
Hand Fractures

Hand fractures are different from other fractures elsewhere in the body. Functional impairment of hand leads to a prominent issue to the patient. We have a common practice of treatment of hand fractures by using kirschner wire(s). The internal fixation using plates and screws for metacarpal fractures of the hand is technically demanding but it is beneficial to the patients as it permits early mobilization and better pain relief. We studied the outcome of this type of internal fixation of the metacarpal fractures at Nepal Medical College. We included 26 patients above 18years with isolated extraarticular, closed and open Swanson I metacarpal fractures of the hand. Fractures with rotation of the digit and unacceptable angulation, shortening and unstable fractures were included. Pain was evaluated by visual analogue scale and function using American Society for Surgery of hand Total Active Flexion (ASSHTAF) score. The mean pain score (VAS) was 0.27 at 12 weeks. The ASSHTAF score showed excellent results in 92.3% patients at 12 weeks. At the final follow up 92.3% patients had excellent results, 3.8% had good and 3.8% had poor results. Fracture union was seen in all patients at final follow up. The study shows that internal fixation of unstable metacarpal fractures gives significant pain relief to the patient and an excellent functional outcome.

scholarly journals Establishment of CTPA Local Diagnostic Reference Levels with Noise Magnitude as a Quality Indicator in a Tertiary Care Hospital

Diagnostics ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. 680
Author(s):  
Hanif Haspi Harun ◽  
Muhammad Khalis Abdul Karim ◽  
Mohd Amiruddin Abd Rahman ◽  
Hairil Rashmizal Abdul Razak ◽  
Iza Nurzawani Che Isa ◽  
...  
Keyword(s):  
Body Size ◽  
Quality Indicator ◽  
Tertiary Care ◽  
Pulmonary Arteries ◽  
The Body ◽  
Care Hospital ◽  
Diagnostic Reference Levels ◽  
Ct Scanner ◽  
Reference Levels ◽  
Dose Length Product

This study aimed to establish the local diagnostic reference levels (LDRLs) of computed tomography pulmonary angiography (CTPA) examinations based on body size with regard to noise magnitude as a quality indicator. The records of 127 patients (55 males and 72 females) who had undergone CTPAs using a 128-slice CT scanner were retrieved. The dose information, scanning acquisition parameters, and patient demographics were recorded in standardized forms. The body size of patients was categorized into three groups based on their anteroposterior body length: P1 (14–19 cm), P2 (19–24 cm), and P3 (24–31 cm), and the radiation dose exposure was statistically compared. The image noise was determined quantitatively by measuring the standard deviation of the region of interest (ROI) at five different arteries—the ascending and descending aorta, pulmonary trunk, and the left and right main pulmonary arteries. We observed that the LDRL values were significantly different between body sizes (p < 0.05), and the median values of the CT dose index volume (CTDIvol) for P1, P2, and P3 were 6.13, 8.3, and 21.40 mGy, respectively. It was noted that the noise reference values were 23.78, 24.26, and 23.97 HU for P1, P2, and P3, respectively, which were not significantly different from each other (p > 0.05). The CTDIvol of 9 mGy and dose length product (DLP) of 329 mGy∙cm in this study were lower than those reported by other studies conducted elsewhere. This study successfully established the LDRLs of a local healthcare institution with the inclusion of the noise magnitude, which is comparable with other established references.

scholarly journals Bloodstream infections and trends of antimicrobial sensitivity patterns at Port Blair

2018 ◽  
Vol 10 (03) ◽  
pp. 332-337 ◽  
Author(s):  
Amit Banik ◽  
Sanjeev H. Bhat ◽  
Abhay Kumar ◽  
Agnijeet Palit ◽  
Kandregula Snehaa
Keyword(s):  
Tertiary Care ◽  
Bloodstream Infections ◽  
The Body ◽  
Diffusion Method ◽  
Blood Collection ◽  
Care Hospital ◽  
Biochemical Tests ◽  
Sensitivity Testing ◽  
Disk Diffusion Method ◽  
Antimicrobial Sensitivity

ABSTRACT PURPOSE: Bloodstream infection can range from inapparent bacteremia until fulminant septic shock with high mortality. Microorganisms present in circulating blood whether continuously, intermittently, or transiently are a threat to every organ in the body. Culture of blood is a vital tool to diagnose such infections. Drug susceptibility patterns help in rationalizing therapy. OBJECTIVE: The objective of this study was to perform bacteriological analysis and assess drug sensitivity patterns of isolates from blood stream infections. DESIGN: Retrospective observational study was conducted from May 2015 to February 2017 at a tertiary care hospital, Port Blair, India. Blood samples were collected with aseptic guidelines and cultured for 7 days. Growths were identified using standard biochemical tests and subjected to sensitivity testing according to Modified Kirby–Bauer’s disk diffusion method. Data for the source of blood collection and duration of incubation were noted and compared. RESULTS: A total of 270 (14.24%) pathogens were isolated from 1895 bacteremia suspect patient blood specimens. Contamination was observed at a rate of 1.63%. Gram-positive cocci (60.37%) were predominant organisms recovered followed by Gram-negative Bacilli (36.29%) and Yeasts (3.33%). Staphylococcus aureus, CoNS, and Acinetobacter spp. were the primary pathogens isolated. Aminoglycosides, carbapenems, and glycopeptides were the most effective drugs for treating bacteremia. CONCLUSIONS: Successful treatment of sepsis depends on early diagnosis and proper antimicrobial therapy. Local knowledge of bacteriological profile and antimicrobial sensitivity patterns helps rationalize empiric treatment strategies.

scholarly journals MORPHOLOGY AND MORPHOMETRY OF SCAPULAE IN TERTIARY CARE HOSPITAL IN K.M. MEDICAL COLLEGE AND HOSPITAL, MATHURA (UP).

2019 ◽  
Vol 3 (11) ◽  
Author(s):  
Dr. Lavlesh Mittal ◽  
Dr. Sandeep Madaan
Keyword(s):  
Shoulder Arthroplasty ◽  
Shoulder Joint ◽  
Total Shoulder Arthroplasty ◽  
Tertiary Care ◽  
The Body ◽  
Care Hospital ◽  
Glenoid Cavity ◽  
Shoulder Dysfunction ◽  
Inverted Comma ◽  
Morphology And Morphometry

Introduction:  The shoulder joint is the most important joint in the body and limitation of this joint movements affects the quality of life. Severe shoulder injury and glenohumeral arthritis causes shoulder dysfunction with devasting results, and to restore normal functions orthopaedic surgeon can perform total shoulder arthroplasty, or reverse shoulder prosthesis, or hemiarthroplasty.Lateral angle of the scapula becomes truncated and broadened and bears the glenoid cavity which articulates with the humerus in the shoulder joint. Shoulder joint is formed when the glenoid cavity is connected with the head of the humerus. This study was carried out to study the morphology and morphometry of the glenoid cavity as dimensions of the glenoid cavity are important in designing and fitting of glenoid components for total shoulder arthroplasty. Material and Methods: A total of 100 unpaired dry scapula were isolated from the department of Anatomy. Two groups were made according to the side of the scapula and were equally divided into 50 right and 50 left scapula each. Bones were segregated and inspected individually.To classifying shape of the glenoid fossa, presence or absence of a glenoid notch was used and were classified into 3 types, pear shaped or inverted comma shape in presence of a glenoid notch & oval in absence of notch. The pear shaped shows indistinct glenoid notch and the inverted comma shaped shows a distinct notch. Results: On the basis of presence or absence of the glenoid notch. 56%, 28% & 16% glenoid cavities of right side were pear shaped, inverted comma shaped and oval shaped respectively. On the left side 60%, 30% & 10%were pear shaped, inverted comma shaped and oval shaped respectively. In total 58% glenoid cavities were pear shaped, 29% were inverted comma shaped and 13% were oval shaped.Average length and breadth of scapulae included in this study was 134.07±13.87 mm and 98.43 ±9.58 mm respectively.Mean glenoid cavity index of right side was 48.12 to 86.87 %, while in left side it was 44.21 – 84.78%. Conclusion: The most common glenoid cavity was pear shaped followed by inverted comma shaped and the oval glenoid cavity. Mean glenoid cavity index of right side was 48.12 to 86.87 %, while in left side it was 44.21 – 84.78%.

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